How to make sure you’re getting real BOTOX at a fair price

Here is some information that we believe will help you make smart, safe choices when it comes to BOTOX.

Not All “BOTOX” is Created Equal!

Unfortunately, the BOTOX® Cosmetic you get at one practice may not be exactly what you get at another. BOTOX Cosmetic (onabotulinumtoxinA) is supplied in a manufacturers’ vial containing 100 units of the vacuum-dried neurotoxin complex. In order to be able to inject these active units of BOTOX, a physician must add saline to get it in “liquid form.” This process enables the BOTOX to be extracted from the vial into the syringe.

Why is Botox diluted?

There are 100 units of BOTOX Cosmetic in every vial. As you can see in Table A (see below), the more saline (in mL) added to the BOTOX vial, the less active units present in every 1/10 mL extracted into the syringe. Some may refer to this is as the dilution process, but it is actually called “reconstitution.” So now, while each practice gets the same product from the manufacturer when they reconstitute it to make it possible to inject, they can add saline at the recommended standard or they can add more saline than recommended.

Table A: Recommendations for Reconstitution and Handling**

Diluent (saline) added to BOTOX vial
(0.9% sodium chloride injection)
Resulting dose/
Units per 0.1 (1/10) mL
1.0 mL 10.0 U
2.0 mL 5.0 U
2.5 mL 4.0 U*
4.0 mL 2.5 U
8.0 mL 1.25 U

* Approved dose is 4 units per 0.1 mL at each of the 5 injection sites for a total dose of 20 units in 0.5 mL.
** Data from the Supplement to Plastic and Reconstructive Surgery, provided by the American Society of Plastic Surgeons.


Beware of Bargain Botox and Ask to See the Label

We don’t want to burst your bubble, but you should be cautious when you see advertisements for BOTOX at bargain prices. Practices pay roughly the same price to get the product from the vendor (Allergan). So how can prices vary so much? This is where the “reconstitution” question becomes very important. Below, Table B illustrates the recommended starting doses of the frequently injected areas.

Table B: Recommended units per area:

You may think you are getting a “good dose” of BOTOX because the physician is injecting a large amount, but don’t confuse the units of saline with the units of actual BOTOX. Physicians who add more saline than suggested by the manufacturer (or such organizations as the American Society of Plastic Surgery) are giving you a less effective injection of BOTOX. So no matter where you go for BOTOX, always ask this question: “What is your reconstitution ratio?

Botox Pricing By The Area

Also, many facilities quote a price based on a particular area. Now, besides your “reconstitution question,” you need to ask, “How many units do you inject in that area?” And that begs the next question—what is their definition of an “area”? For instance, a practice may advertise $99 per area, but may actually be breaking up the crow’s feet area into two areas when in most practices, it is considered one area.

So buyers beware! At La Jolla Cosmetic Medical Spa, we charge by the unit for BOTOX, so you only pay for the exact number of units you receive. Also, we follow the American Society of Plastic Surgery (ASPS) guidelines on “reconstitution,” so you are assured of the efficacy of the product. Our providers will discuss with you which areas on your face should receive injections to best meet your concerns, and they will tell you how many units of BOTOX you will need to attain your desired result.

Table C: Variables Influencing Treatment Plan*

Variable Effect
Aesthetic goals Development of overall treatment plan
Region(s) to be injected Dose, injection sites, retreatment interval
Gender Usually higher doses for men; aesthetic goals
Muscle Mass Higher doses for larger muscles
Ethnicity Aesthetic ideals, skin thickness, functional anatomy
Skin Thickness Higher doses may be needed for thicker skin

* Data from the Supplement to “Plastic and Reconstructive Surgery” provided by the American Society of Plastic Surgeons.

If you’re considering BOTOX, you want to be as educated as possible. You should always do your own research. If you’re well-informed, you can help to ensure the safety of your treatment and your satisfaction with the results.

Quick Summary:

  • Confirm you are a candidate for BOTOX
  • Confirm exactly what is being used in your treatment (ask to see the label)
  • Ask about reconstitution ratio
  • Confirm the qualifications of the person performing your BOTOX treatment
  • Understand the number of units being used in each area of treatment
  • Ask the office policy on charges if additional units are needed

Works Cited